Mariah Dee Shannon Goldston, CG

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

2504 E Fourth Plain Blvd
Vancouver, WA 98661-3965

Phone

(360) 831-0904

Fax

(360) 433-9917

NPI assigned

Feb 17, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mariah Dee Shannon Gordon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Youth Villages

  • Community/Behavioral Health Agency
  • Lake Oswego, OR
  • NPI 1740729490
  NPD (past)
• Youth Villages

  • Adolescent and Children Mental Health Clinic/Center
  • Lake Oswego, OR
  • NPI 1992243992
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1821681297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703",
            "telephone_number": "253-681-6603",
            "fax_number": "206-764-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 E FOURTH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613965",
            "telephone_number": "360-831-0904",
            "fax_number": "360-433-9917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDSTON",
        "first_name": "MARIAH",
        "middle_name": "DEE SHANNON",
        "credential": "CG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-17",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIAH",
            "last_name": "GORDON",
            "middle_name": "DEE SHANNON",
            "credential": "CG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristina Goldinov
• Olga N Goldinov, FNP
• Debra Ann Goldstein, CNM
• Joshua Brandon Goldstein, FNP
• George Michael Goldston Jr.
• Jennifer E Golik
• Sumona Marie Gomes
• Victor Gomes, ARNP, PMHNP-BC
• Katherin Gomez-Arboleda
• Virginia Gomez

• Counselor in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.